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Q: I am a 42 years old female. For the past three weeks I have had a tender area under my right ribcage. Pains come and go also, with a vague sense of uncomfortableness constantly. My doctor did a liver battery, hepatitis testing, upper GI, and gallbladder ultrasound, with all tests being normal. He now tells me not to worry about it, that it might be viral. My appetite is fine. I'm more tired lately, and do not have fever. What would your suggestion be as to the cause?
A: Abdominal pain in the right upper quadrant of the abdomen is usually due to inflammation, trauma, or vascular disorders. Thus, for example, the liver can be inflammed from hepatitis, the gallbladder may be inflammed due to stones and bacteria, the bile ducts may als be inflammed, the colon can be inflammed from various conditions, the small bowel can be affected due to ulcers, or the pancreas can be inflammed due to pancreatitis. Regarding trauma, the patient may not give a history of trauma but he/she may may, for example, have muscular pain due to, say, coughing hard. Vascular conditions include, for example, thrombosis (clot formation leading to narrowing of the affected vessel). In addition, disorders originating outside the abdomen may also lead to right upper quadrant abdominal pain. For example, the skin may be affected from a herpes infection or due to skin inflammation, etc.
In your particular case, your doctor has already done a liver battery, hepatitis testing, upper GI, and gallbladder ultrasound. The fact that these tests are normal is encouraging and rules out many possible causes. There is one test, however, that it appears not to have been yet performed in your case, which would be worthwhile to perform. This particular test is a either a barium enema or a colonoscopy. A barium enema is a radiographic imaging study of the bowel by ingestion of a substance which permits a good radiographic analysis ofthis structurel. On the other hand, a colonoscopy consists in inserting a tube through the anus to carefully visualize the bowel. Clearly the latter test is superior since it permits more accurate visualization of the entire bowel wall and removal of certain nonmalignant growths without having to undergo surgery. In your case, it would probably be a good idea to also have this test performed for completeness, in order to rule out that the reason for this pain may be originating in the colon.
Updated: 05/23/99
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